Yorston David B, Wood Mark L, Gilbert Clare
Kikuyu Eye Unit, Kikuyu, Kenya.
Ophthalmology. 2002 Dec;109(12):2279-83. doi: 10.1016/s0161-6420(02)01284-8.
To report the causes of retinal detachment in an African setting and the outcome after surgery.
Noncomparative interventional case series.
A total of 361 eyes in 345 patients.
Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression.
Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation.
The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up.
Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.
报告非洲地区视网膜脱离的病因及手术治疗效果。
非对照性干预病例系列研究。
345例患者共361只眼。
从患者病历中收集数据。254只眼获得了至少2个月的随访。通过逻辑回归分析解剖或视力预后不良的危险因素。
初次解剖成功，定义为初次手术后至少2个月视网膜复位，无需任何额外干预；最终解剖成功，定义为最近一次干预后至少2个月视网膜复位；视力预后，定义为最后一次手术后至少2个月的矫正视力。
就诊时黄斑脱离的有332只眼（91.9%）。203只眼（56.2%）视网膜脱离超过1个月。63只眼（17.5%）存在增殖性玻璃体视网膜病变（PVR）C1级或更严重级别。30只眼（8.3%）有巨大视网膜裂孔。95例患者（27.5%）就诊时失明（较好眼视力<20/400）。186只眼（73.2%）通过1次手术成功使视网膜复位。初次手术失败最常见的原因是遗漏裂孔或出现新裂孔。最后一次手术后至少观察8周的眼最终解剖成功率为88.2%。巨大视网膜裂孔和PVR是解剖失败的显著独立预测因素。视网膜成功复位的眼中，63.9%的患者视力达到20/200或更好。在黄斑脱离复位成功的病例中，视力预后不良（<20/200）的危险因素包括黄斑裂孔、视网膜脱离持续时间>1个月以及术前视力差。在74例有2个月随访的失明患者中，最新随访时只有23例（31.1%）仍为失明。
视网膜脱离在非洲是可治疗的致盲原因。尽管就诊较晚且病理情况复杂，但手术修复常常成功，且常能恢复导航视力。在眼科医生和基层眼保健工作者的区域培训项目中，应更加强调对视网膜脱离的识别和治疗。
